Essay examples --

IntroductionAs the number of Americans covered by managed c are plans grows, it becomes more important to see how managed divvy up organizations (MCOs) take hold costs and how these controls affect adit, quality, and health outcomes. This paper pull up stakes examine patterns in referrals from primary dole out physicians (PCPs) to specialists in order to label physicians satisfaction with this inter-physician communication and to identify problems in the referral process. Prior empowerments go away likewise be studied in order to learn the criteria considered when deciding if a treatment or medication is medically necessary and appropriate. The reasons prior authorization systems are utilized and their effectiveness in controlling costs and limit access will also be examined. Case management as a function of utilization management and methods for measuring quality and long-suffering satisfaction will be discussed. Historical patterns of upshot management will be studied in order to evaluate the effectiveness of case management in managing costs. The implications of referral and prior authorizations systems for all stakeholders, MCOs, purchasers, providers, and consumers will be considered. stage setting/UnderstandingIn MCOs, there are a variety of processes that are used to influence the practice style of a PCP. The method that causes ane of the most controversial and frustrating aspects of managed care for the members and their PCP is the use of referral systems (Grumbach et al, 1998). A referral system is the process in which PCPs determine whether services that are performed exterior of their office are medically necessary and appropriate. These referrals are used to accuse members to other physicians in order to gain the excess amount of care t... ...spects of care including, rehabilitation, home care, and health education. MCOs can also utilize complaint management, which is a alter form of case management to monitor and control certain individuals with specialized needs. Like case management, disease management is targeted at specific high risk and high cost medical cases however with a focus on diseases. Disease management is unique because it offers patients access to not only physicians but also other types of health care professionals including pharmacists and dieticians. The idea behind this is to provide each patient with all getable resources to help control or eliminate their disease. Pharmacists can provide specialized knowledge on medication techniques and types while dietitians can provide tuition on healthy eating habits that can help ease symptoms of special(prenominal) diseases (Kongstvedt, 2009).